Brain Tumours (Clinical)

Question 1

What are the common types of primary brain tumour?

Answer 1

• glioma of the neuroepithelial tissue
• Meningioma
• Pituitary adenoma

Question 2

What are the most common cancers that metastasize to the brain? (secondary brain tumours)

Answer 2

• Renal cell carcinoma
• Lung carcinoma
• Breast carcinoma
• Malignant melanoma
• GI tract malignancy

Question 3

Are primary or secondary brain tumours more common?

Answer 3

Secondary

>100,000/year in US vs 17,000 primary

Question 4

What CNS cells are gliomas derived from? How are gliomas graded by the WHO?

Answer 4

• Derived from astrocytes / ependymal cells / oligodendrocytes
• Graded I-IV by WHO

Question 5

What is the most common type of glioma? What grade is it? How does it tend to progress?

Answer 5

• Glioblastoma Multiforme (GBM)
  (glioblastoma multiforme is a grade 4 astrocytoma)
• Grade IV
• Aggressive tumour, but doesn’t tend to spread systemically

Question 6

Characteristics of meningiomas? Location/progression/layer of meninges

Answer 6

• Slow growing, usually benign. Usually cured if completely removed
• Usually located along flax cerebri, convexity or sphenoid
• Arise from arachnoid

Question 7

Characteristic of pituitary tumours? Most common type/specific presentation

Answer 7

• Adenoma most common, only 1% tumours malignant

- Present with visual disturbance and hormone imbalance

Question 8

Common clinical presentation of intracranial tumours?

Answer 8

• Raised ICP effects
• Focal neurological deficit
• Epileptic fits
• CSF obstruction

Question 9

Symptoms of raised ICP?

Answer 9

• Headache
• Nausea / vomiting
• Visual disturbances (DV / diplopia)
• Somnolence (sleepiness)
• Cognitive impairment
• Altered consciousness

Question 10

Clinical signs of raised ICP?

Answer 10

• Papilloedema
• 6th nerve palsy (eye adducted)
• Cognitive impairment
• Altered consciousness
• 3rd nerve palsy

Question 11

What type of tumours are likely to cause hydrocephalus?

Answer 11

• Tumours in or close to CSF pathways

- Especially in posterior fossa & in children

Question 12

Investigations when suspected brain tumour?

Answer 12

• CT & MRI scans
• PET scan
• Think of secondary sources (eg. CXR)
• Biopsy

Question 13

What is papilloedema and how does it appear on fundoscopy?

Answer 13

• Swelling of optic disc due to raised ICP

- Optic disc margins blurred on fundoscopy
+/- engorged veins / reduced pulsation

Question 14

What are some focal neurological deficits encountered with brain tumours / raised ICP?

Answer 14

• Hemiparesis (weakness of one side of body)
• Dysphasia
• Hemianopia
• Cognitive impairment (memory / direction etc.)
• Cranial nerve palsy
• Endocrine disorders

Question 15

What is ataxia?

Answer 15

Term to describe disorders that affect speech, coordination and balance

Question 16

Go over this lecture it’s got some good scenarios for exam practice

Answer 16

horny

Question 17

What types of tumours might cause epileptic fits?

Answer 17

Epilepsy only caused by lesions above the tentorium cerebelli

Question 18

What can be an important step after excising a tumour from the brain?

Answer 18

• Tissue biopsy

Indicates whether it’s a metastases or primary

Question 19

Treatment of brain tumours?

Answer 19

• Surgery
• Radio/chemo therapy

other:

• Epilepsy treatment
• hormone / endocrine therapy
• Analgesics

Question 20

How does glioblastoma multiforme tend to respond to treatment?

Answer 20

• Complete surgical excision tends to be impossible

Biopsy/debulk only

Question 21

What is the prognosis for the different types of intracranial cancer?

Answer 21

• Meningioma: commonly cured by surgery, anticonvulsants
• Astrocytomas: low grade - long life expectancy, high grade / GBM - avg. 1 year survival
• Metastases: frequently good but depends

Question 22

Should you do a lumbar puncture when there are signs suggesting an intracranial mass lesion? Why?

Answer 22

• Definitely not

- Raised ICP due to the mass means CSF will rush out of the puncture hole if the hole is made